Terms and Conditions
1. Description of Services
Service Inclusions: The clinic agrees to provide chiropractic services, which may include initial consultations, physical examinations, spinal manipulation, soft tissue therapy, and rehabilitation exercises, as deemed appropriate by the licensed chiropractor.
Modification of Treatment Plan: The treatment plan may be adjusted based on the patient's progress, evolving needs, and response to therapy, with ongoing evaluation.
2. Patient Responsibilities
Accurate Information: The patient agrees to provide accurate and complete medical history and to communicate any changes in their health status throughout the course of treatment.
Attendance and Cancellation: Patients are responsible for attending all scheduled sessions. The clinic requires [e.g., 24 hours'] notice for cancellation to avoid a potential fee.
Following Recommendations: It is the patient's responsibility to follow all instructions and recommendations provided by the chiropractor.
3. Payment for Services
Fees and Payment Timing: Fees for services are generally due at the time of the visit, unless prior arrangements (e.g., insurance assignment) have been made.
Insurance and Medicare: The patient understands that health and accident insurance policies are an arrangement between the carrier and the patient. While the clinic may assist in filing claims, the patient is personally responsible for payment of all services, including co-pays, deductibles, and non-covered services. Patients are responsible for charges for services deemed not "medically necessary" by their insurance provider.
No Health Insurance Substitute: This agreement is not an insurance plan or a substitute for health insurance. The patient is advised to maintain health insurance for healthcare not provided by the clinic.
4. Disclaimers and Limitation of Liability
No Guarantee of Results: The patient acknowledges that results from chiropractic care cannot be guaranteed, as each individual's response to treatment may vary.
Assumption of Risk: The patient acknowledges that chiropractic treatment, including spinal adjustments, involves potential risks such as temporary soreness or mild discomfort, and voluntarily agrees to proceed with treatment.
Limitation of Liability: The clinic, its practitioners, and staff are not liable for injuries or damages caused by pre-existing conditions, the patient's failure to disclose health information, or failure to follow the treatment plan.
5. Confidentiality and Privacy
Patient health information will be kept confidential according to applicable privacy laws, such as HIPAA. Information is not shared with third parties without consent, unless legally required. A detailed privacy policy is available for review.
6. Governing Law and Agreement
This document represents the complete understanding between the patient and the clinic. Any disputes related to this agreement will be subject to the laws of the state where the clinic is located.